NEw Client Inquiry

Thank you for your interest in working with me. Please note ALL appointments will be by Phone or Video.

If you’re interested in 1:1 therapy or coaching, please complete this inquiry form and I will respond within 48 business hours.

Name

First Name

Last Name

Phone

(###)

###

####

Email

Message

Inquiring about

Therapy (Illinois or Alberta Residents)

Supervision & Business Mentorship

Something else

I consent to receiving periodic marketing and communication emails from Dallis.

Yes, please.

No, thank you.

CLIENT PORTAL & ONLINE BOOKING